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Filgueiras LV, Konflanz W, Haas AN, Celeste RK. Assessment of the contextual effects on the prevalence of periodontitis: a systematic review. Braz Oral Res 2023; 36:e0125. [PMID: 36651384 DOI: 10.1590/1807-3107bor-2022.vol36.0125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 06/02/2021] [Indexed: 01/17/2023] Open
Abstract
This study reviews the influence of contextual factors on periodontitis based on a systematic search of studies recorded in the PubMed, Scopus, Web of Science, and EMBASE databases. Periodontitis was assessed by clinical attachment loss and probing depth for studies with data on the socioeconomic status (SES) of a specific area (area-level SES) or dental care service (service-level) in a catchment area among individuals aged 18 and over. Two independent reviewers performed study selection, data extraction, and assessment of methodological quality. Of the 646 articles identified, 13 were included in the systematic review, representing 101,362 individuals from five countries (USA, UK, Brazil, China, and Uruguay). A higher prevalence of periodontitis was described in lower SES neighborhoods, more deprived postcodes, and poorer provinces. Gini Index results were mixed and inconclusive. Three studies showed that higher coverage of primary dental care at the municipal level was associated with a lower prevalence of periodontitis. Contextual factors at the area-level SES and dental care service might influence periodontitis, but the existing evidence is unclear. The contextual effect is important for periodontal health and may contribute to the prevalence of periodontitis, independent of well-known risk factors and individual levels.
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Affiliation(s)
- Leonardo Vilar Filgueiras
- Universidade Federal do Rio Grande do Sul - UFRGS, Department of Preventive and Social Dentistry, Porto Alegre, RS, Brazil
| | - Willian Konflanz
- Universidade Federal do Rio Grande do Sul - UFRGS, Department of Periodontology, Porto Alegre, RS, Brazil
| | - Alex Nogueira Haas
- Universidade Federal do Rio Grande do Sul - UFRGS, Department of Periodontology, Porto Alegre, RS, Brazil
| | - Roger Keller Celeste
- Universidade Federal do Rio Grande do Sul - UFRGS, Department of Preventive and Social Dentistry, Porto Alegre, RS, Brazil
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Systematic Review of the Literature on Dental Caries and Periodontal Disease in Socio-Economically Disadvantaged Individuals. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182312360. [PMID: 34886085 PMCID: PMC8656978 DOI: 10.3390/ijerph182312360] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 11/12/2021] [Accepted: 11/19/2021] [Indexed: 12/23/2022]
Abstract
Dental caries and periodontal disease represent a health problem and a social cost for the entire population, and in particular for socio-economically disadvantaged individuals who are less resistant to disease. The aim of this review is to estimate the prevalence and severity of the two dental pathologies, caries and periodontal disease, in the different classes of socio-economically disadvantaged subjects and to understand which of them are most affected. A systematic search of the literature was performed in MEDLINE (via PubMed), EMBASE and Web of Science after establishing a suitable search strategy for each database, using keywords related to socio-economically vulnerable classes and health outcomes. Socio-economically disadvantaged individuals are more susceptible to tooth decay and periodontal disease (with relative tooth loss) than non-vulnerable people. Additionally, when multiple vulnerabilities are combined in the same subject, these oral diseases worsen. There is no type of vulnerability more affected by caries and periodontitis than others, since overall they all have severe disease indices. The data from this systematic literature review might be useful for health policy makers looking to allocate more resources and services to socially disadvantaged individuals, resulting in making them more resilient to oral disease due to their social marginalization.
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Mao W, Wu B, Chi I, Yang W, Dong X. Acculturation and Subsequent Oral Health Problems Among Foreign-Born Older Chinese Americans: Does Neighborhood Disorder Matter? Res Aging 2021; 44:231-240. [PMID: 34002640 DOI: 10.1177/01640275211018785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To investigate the relationship between acculturation and subsequent oral health problems in older Chinese Americans and to further test the moderating role of neighborhood disorder in such a relationship. METHODS The working sample included 2,706 foreign-born community-dwelling older Chinese Americans aged 60 years or older who participated in the Population Study of Chinese Elderly in Chicago at baseline between 2011 and 2013 and the 2-year follow-up between 2013 and 2015. Stepwise Poisson regressions with lagged dependent variable were conducted. RESULTS Behavioral acculturation was protective against subsequent oral health problems, and the protective role was stronger among individuals reporting lower levels of neighborhood disorder. Residence in Chinatown was associated with an increase in the risk of subsequent oral health problems. DISCUSSION To reduce oral health symptoms and related burdens, it is important to consider, in practice and policy, the role of acculturation and the neighborhood on subsequent oral health outcomes.
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Affiliation(s)
- Weiyu Mao
- School of Social Work, University of Nevada, Reno, NV, USA
| | - Bei Wu
- Rory Meyers College of Nursing, New York University, NY, USA
| | - Iris Chi
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA, USA
| | - Wei Yang
- School of Community Health Sciences, University of Nevada, Reno, NV, USA
| | - XinQi Dong
- Institute for Health, Health Care Policy and Aging Research, Rutgers University, New Brunswick, NJ, USA
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Mao W, Wu B, Chi I, Yang W, Dong X. Neighborhood Cohesion and Oral Health Problems Among Older Chinese American Immigrants: Does Acculturation Make a Difference? THE GERONTOLOGIST 2020; 60:219-228. [PMID: 31565728 DOI: 10.1093/geront/gnz126] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Despite an increasing, yet still limited amount of research on social determinants of oral health, the influences of neighborhood characteristics remain understudied, especially within the context of immigration. Acculturation is multidimensional, and its influences on the oral health of immigrants vary across age and ethnic groups. This study investigated the relationship between neighborhood cohesion and oral health problems among older Chinese American immigrants, and whether and to what extent acculturation indicators moderate the relationship between such cohesion and oral health. METHODS The research design and working sample included 3,157 older Chinese American immigrants aged 60 years or older from the baseline of the Population Study of Chinese Elderly in Chicago. Neighborhood cohesion was measured by a six-item scale. Oral health problems were measured by the presence or absence of such problems. Acculturation included residence in ethnic enclaves, length of stay, and behavioral acculturation. Stepwise logistic regression models with interaction terms (Neighborhood cohesion × Acculturation) were conducted to examine the association between neighborhood cohesion and oral health problems, accounting for sociodemographics, health conditions, and health behaviors. RESULTS Individuals experiencing higher levels of neighborhood cohesion reported a lower likelihood of having oral health problems. The protective effect of neighborhood cohesion against having oral health problems was stronger when individuals resided in ethnic enclaves such as Chinatown. DISCUSSION AND IMPLICATIONS To promote optimal oral health, interventions need to account for individuals' perceptions and levels of integration into their neighborhoods and communities.
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Affiliation(s)
- Weiyu Mao
- School of Social Work, University of Nevada, Reno, Los Angeles
| | - Bei Wu
- Rory Meyers College of Nursing, New York University, Los Angeles
| | - Iris Chi
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles
| | - Wei Yang
- School of Community Health Sciences, University of Nevada, Reno, New Brunswick, New Jersey
| | - Xinqi Dong
- Institute for Health, Health Care Policy and Aging Research, Rutgers University, New Brunswick, New Jersey
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Lorenzo-Erro SM, Massa F, Álvarez-Vaz R, Schuch HS, Correa MB, Peres MA. The role of contextual and individual factors on periodontal disease in Uruguayan adults. Braz Oral Res 2018; 32:e62. [PMID: 29995066 DOI: 10.1590/1807-3107bor-2018.vol32.0062] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Accepted: 05/23/2018] [Indexed: 11/22/2022] Open
Abstract
The present study aimed at understanding the relationship between periodontitis and socio-contextual and individual determinants of health. Data from "The First Uruguayan Oral Health Survey, 2011", which included 223 and 455 individuals with 35-44 and 65-74 years old respectively, were used. A stratified, multistage cluster sampling design was adopted (cities with ≥ 20.000 residents). Periodontitis was assessed using the modified Community Periodontal Index (CPI) and clinical attachment loss (CAL) (periodontal pocket and CAL ≥ 4 mm). Independent variables included contextual socioeconomic status (SES) measured by proportion of houses with Unsatisfied Basic Needs (UBN) and individual demographic and behavioral factors. Logistic regression multilevel models were generated. Living in contexts with a higher UBN was associated with higher odds for periodontitis in both age groups, even when adjusting for individual level variables (odds ratio [OR] = 1.51, 95%CI = 1.42-1.60 and 1.31, 95%CI = 1.21-1.42, respectively). Being male or heavy smoker increased the odds of periodontitis in this population for both age groups. Social structure impacts periodontal disease by modifying individual socioeconomic situations: in better socioeconomic context, UBN acts increasing the protector role of socioeconomic situation but in a poverty context the role is attenuated. Conclusions for this study are that periodontitis varies across contextual socio-demographic groups being higher in the population with a lower SES, challenging health authorities to integrate oral health into national non-communicable diseases programs.
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Affiliation(s)
| | - Fernando Massa
- University of the Republic of Uruguay, School of Dentistry, Epidemiology and Statistic Unit, Montevideo, Uruguay
| | - Ramón Álvarez-Vaz
- University of the Republic of Uruguay, Statistic Institute School of Economy, Montevideo, Uruguay
| | - Helena Silveira Schuch
- The University of Adelaide, Australian Research Centre for Population Oral Health, Adelaide Dental School, Australia
| | - Marcos Britto Correa
- Universidade Federal de Pelotas - UFPel, School of Dentistry, Graduate Program in Dentistry, Pelotas, RS, Brazil
| | - Marco Aurélio Peres
- The University of Adelaide, Australian Research Centre for Population Oral Health, Adelaide Dental School, Australia
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An Umbrella Review Exploring the Effect of Periodontal Treatment in Pregnant Women on the Frequency of Adverse Obstetric Outcomes. J Evid Based Dent Pract 2017; 18:218-239. [PMID: 30077375 DOI: 10.1016/j.jebdp.2017.10.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Revised: 10/27/2017] [Accepted: 10/27/2017] [Indexed: 12/22/2022]
Abstract
OBJECTIVE In the recent years, efforts have been made to reduce epidemiologic indicators of periodontal disease in pregnant women. This umbrella review aims to analyze the systematic reviews/meta-analyses investigating the effect of periodontal therapy in pregnant women on the frequency of obstetric complications (low birth weight, preterm delivery, and preeclampsia) and to identify the gaps in the scientific literature. METHODS A systematic review of systematic reviews with and without meta-analysis of intervention studies was conducted. Quality evaluation and qualitative analysis of the reviews were performed. RESULTS A total of 223 articles were obtained, and 18 of them were included in the analysis, 13 articles included meta-analysis, where 11 were of high quality and 7 of medium quality according to the Assessing the Methodological Quality of Systematic Reviews (AMSTAR) guide. These systematic reviews/meta-analyses included a total of 19 studies (17 randomized clinical trials). Descriptive systematic reviews showed that periodontal therapy has positive effects on reducing the frequency of adverse pregnancy outcomes. In systematic reviews with meta-analysis, overall effect estimators were not significant, although a reduction in the incidence of obstetric complications was observed. Subgroup analysis resulted in significant effects, depending on sociodemographic conditions. CONCLUSIONS Differential findings are not enough to demonstrate that there is a significant reduction in the frequency of adverse pregnancy outcomes in pregnant women receiving periodontal therapy. Possible explanations are related to factors such as the type of studies analyzed, indicator of obstetric complication considered, and specific variables included in the analysis. Many systematic reviews did not address publication bias and did identify gaps in knowledge that require further clarification.
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Sun X, Bernabé E, Liu X, Zheng S, Gallagher JE. Meeting the oral health needs of 12-year-olds in China: human resources for oral health. BMC Public Health 2017; 17:586. [PMID: 28633647 PMCID: PMC5477685 DOI: 10.1186/s12889-017-4384-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Accepted: 05/07/2017] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND An appropriate level of human resources for oral health [HROH] is required to meet the oral health needs of population, and enable maximum improvement in health outcomes. The aim of this study was to estimate the required HROH to meet the oral health needs of the World Health Organization [WHO] reference group of 12-year-olds in China and consider the implications for education, practice, policy and HROH nationally. METHODS We estimated the need of HROH to meet the needs of 12-year-olds based on secondary analysis of the epidemiological and questionnaire data from the 3rd Chinese National Oral Health Survey, including caries experience and periodontal factors (calculus), dentally-related behaviour (frequency of toothbrushing and sugar intake), and social factors (parental education). Children's risk for dental caries was classified in four levels from low (level 1) to high (level 4). We built maximum and minimum intervention models of dental care for each risk level, informed by contemporary evidence-based practice. The needs-led HROH model we used in the present study incorporated need for treatment and risk-based prevention using timings verified by experts in China. These findings were used to estimate HROH for the survey sample, extrapolated to 12-year-olds nationally and the total population, taking account of urban and rural coverage, based on different levels of clinical commitment (60-90%). RESULTS We found that between 40,139 and 51,906 dental professionals were required to deliver care for 12-year-olds nationally based on 80% clinical commitment. We demonstrated that the majority of need for HROH was in the rural population (72.5%). Over 93% of HROH time was dedicated to prevention within the model. Extrapolating the results to the total population, the estimate for HROH nationally was 3.16-4.09 million to achieve national coverage; however, current HROH are only able to serve an estimated 5% of the population with minimum intervention based on a HROH spending 90% of their time in providing clinical care. CONCLUSIONS The findings highlight the gap between dental workforce needs and workforce capacity in China. Significant implications for health policy and human resources for oral health in this country with a developing health system are discussed including the need for public health action.
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Affiliation(s)
- Xiangyu Sun
- Department of Preventive Dentistry, Peking University School and Hospital of Stomatology, National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing Key Laboratory of Digital Stomatology, 22 Zhongguancun Avenue South, Haidian District, Beijing, 100081 People’s Republic of China
- King’s College London Dental Institute at Guy’s, King’s College and St Thomas’ Hospitals, Population and Patient Health Division, London, SE5 9RS UK
| | - Eduardo Bernabé
- King’s College London Dental Institute at Guy’s, King’s College and St Thomas’ Hospitals, Population and Patient Health Division, London, SE5 9RS UK
| | - Xuenan Liu
- Department of Preventive Dentistry, Peking University School and Hospital of Stomatology, National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing Key Laboratory of Digital Stomatology, 22 Zhongguancun Avenue South, Haidian District, Beijing, 100081 People’s Republic of China
| | - Shuguo Zheng
- Department of Preventive Dentistry, Peking University School and Hospital of Stomatology, National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing Key Laboratory of Digital Stomatology, 22 Zhongguancun Avenue South, Haidian District, Beijing, 100081 People’s Republic of China
| | - Jennifer E. Gallagher
- King’s College London Dental Institute at Guy’s, King’s College and St Thomas’ Hospitals, Population and Patient Health Division, London, SE5 9RS UK
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